Podcasts about CSF

We review diagnosing and managing bacterial meningitis in the ED. Hosts: Sarah Fetterolf, MD Avir Mitra, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Meningitis_2_0.mp3 Download Leave a Comment Tags: CNS Infections, Infectious Diseases, Neurology Show Notes Core EM Modular CME Course Maximize your commute with the new Core EM Modular CME Course, featuring the most essential content distilled from our top-rated podcast episodes. This course offers 12 audio-based modules packed with pearls! Information and link below.  Course Highlights: Credit: 12.5 AMA PRA Category 1 Credits™ Curriculum: Comprehensive coverage of Core Emergency Medicine,  with 12 modules spanning from Critical Care to Pediatrics. Cost: Free for NYU Learners $250 for Non-NYU Learners Click Here to Register and Begin Module 1 Patient Presentation & Workup Patient: 36-year-old male, currently shelter-domiciled, presenting with 3 weeks of generalized weakness, fevers, weight loss, and headaches. Vitals (Initial): BP 147/98, HR 150s, Temp 100.2°F, RR 18, O2 99% RA. Clinical Evolution: Initial assessment noted cachexia and a large ventral hernia. Following initial workup, the patient became acutely altered (A&O x0) and febrile to 102.9°F. Physical Exam Findings: Brudzinski Sign: Positive (knees flexed upward upon passive neck flexion). Kernig Sign: Discussed as highly specific (resistance/pain during knee extension with hip flexed at 90°). Meningeal Triad: Fever, nuchal rigidity, and AMS (present in 40% of cases; 95% of patients have at least two of the four cardinal symptoms including headache). Imaging: Chest X-ray: Scattered opacities (pneumonia) and a small pneumothorax. CT Abdomen/Pelvis: Confirmed asplenia (secondary to 2011 GSW/exploratory laparotomy). Head CT: Ventricle enlargement concerning for obstructive hydrocephalus and diffuse sulcal effacement. CSF Analysis & Microbiology Bacterial Meningitis Opening Pressure: Elevated (Normal is 1000–2000/mm3 WBC); dominated by neutrophils (>80% PMN). Glucose: Low (

Daniel Gewolb guides Jennifer Gillespie and Francis Deng through a series of skull base MRI scenarios. Includes discussion of neurovascular compression, pulsatile tinnitus, skull base osteomyelitis, CSF leak and more. Meanwhile, we learn that Frank is a naughty boy who breaks rules.   Radiopaedia Lecture Collection ► https://radiopaedia.org/courses/lecture-collection Radiopaedia 2026 ► https://radiopaedia.org/courses/radiopaedia-2026-virtual-conference Become a supporter ► https://radiopaedia.org/supporters Get an All-Access Pass ► https://radiopaedia.org/courses/all-access-course-pass Radiopaedia Community chat ► http://radiopaedia.org/chat Ideas and Feedback ► podcast@radiopaedia.org   The Reading Room is a radiology podcast intended primarily for radiologists, radiology registrars and residents. 

Behind closed doors, lawmakers decide the future of hunting, fishing, and access to public lands.   Host Fred Bird sits down with a panel of seasoned policy experts to unpack one of the most consequential issues facing hunters and anglers today: the fight over public lands and wildlife management. This isn't surface-level debate—it's a clear-eyed look at how decisions are actually made, who influences them, and why sportsmen need to pay attention long before legislation hits the headlines.   Joined by CSF's Sr VP Taylor Schmitz, and Delta Waterfowl's Chief Policy Officer, John Devney and VP of Government Affairs, Cyrus Baird, the crew breaks down the recent public lands battle and explains the formal process that governs how federal lands are managed, from National Wildlife Refuges to multi-use landscapes critical for hunting access and fishing opportunity. Listeners will gain insight into the outsized role state legislators play in shaping land use policy, wildlife funding, and access for future generations of hunters, anglers, and outdoor families.   Fred and his guests also explore the growing importance of caucus networks—organized groups of lawmakers and advocates working behind the scenes to protect wildlife habitat, sustain public access, and keep conservation grounded in sound science. The discussion highlights the challenges facing the National Wildlife Refuge System, including declining awareness and the real consequences that come with disengaged communities.   This episode equips sportsmen with the context needed to engage intelligently, advocate effectively, and ensure America's public lands remain places where hunting, fishing, and outdoor traditions can thrive.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter  Learn more about your ad choices. Visit megaphone.fm/adchoices

You start with Quick Tips that tighten up your daily Apple workflow fast. You learn how CarPlay scrubbing actually works while driving, how Siri can jump forward or back in precise time chunks, and why Apple's vision for Siri, Gemini, and personal intelligence matters more than the hype suggests. You unlock practical wins like copying Voice Memos transcripts, using Continuity for clipboard magic across devices, mastering iPhone copy and paste gestures, and understanding when dragging photos quietly converts them to JPEGs. Along the way, you revisit Apple Newton roots, discover why tools like Yoink still matter, and pick up slick tricks for prepping images in Messages and pausing voice recordings mid-thought. Then you move into real-world problem solving. You figure out how to record a selfie video on iPhone while reading a script without breaking your flow, why Sign in With Apple is still worth using, and how to monitor drive health without guessing. You finally get clarity on weird Trash behavior, stop your mouse from waking your Mac, and understand why green bubble RCS and SMS sometimes fail on macOS. The episode wraps with a discussion about Apple Creator Studio tools like Logic Pro, Final Cut Pro, Pixelmator Pro, Compressor, MainStage, and premium content across Apple's productivity apps. Listen to sharpen your instincts so when it counts, you Don't Get Caught. 00:00:00 Mac Geek Gab 1125 for Monday, January 19th, 2026 January 19th: Brew a Potion Day MGG Monthly Giveaway – Enter to win a copy of Ecamm Live or Carbon Copy Cloner 7! The MGG Merch Store is Live! MGG's CES 2026 Sponsors: BusyCal (with code MACGEEK10)! Eero Ecamm for Zoom integration MacPaw CCC Backup Quick Tips 00:00:01 Chris-QT-CarPlay lets you scrub while driving 00:04:01 QT-Use Siri to skip forwards and backwards in specific time increments 00:06:18 The future of Siri, Gemini, and Personal Intelligence 00:14:33 QT-See and copy transcripts from Voice Memos 00:15:44 QT-Continuity works for Clipboard Too 00:18:21 iPhone Copy/Paste Gestures 00:21:55 Doug-QT-Dragging photos on iPhone converts them to JPEG Copying/Pasting on the Apple Newton Yoink 00:27:01 Jeff-QT-Dragging an image into Messages preps it to send 00:28:15 Pete-QT-Pause Voice Recording on iOS 00:29:54 How do I record a selfie video on my iPhone while being able to read a script? Teleprompter for Video for iPhone Also Teleprompter is free with in app purchases 00:34:43 GW-QT-Don’t forget about Sign in With Apple Sponsors 00:38:50 SPONSOR: Tempo. For a limited time, Tempo is offering my listeners SIXTY PERCENT OFF your first box! Go to TempoMeals.com/MGG. 00:40:22 SPONSOR: Stamps.com. Try Stamps dot com risk-free for sixty days at stamps.com and use code mgg! Sixty days gives you plenty of time to see exactly how much time and money you’re saving on every shipment. 00:41:42 SPONSOR: CleanMyMac. Get Tidy Today! Try 7 days free and use our code MACGEEK for 20% off at clnmy.com/MACGEEK Your Questions Answered and Tips Shared! 00:43:12 Andy-What should I use to monitor drive health? Disk Drill DriveDx Techtool Pro for repairing APFS volumes 00:48:52 Gary-Why Sometime Trash? Why Sometimes NO Trash? 00:59:37 Andrew-How can I keep my mouse from waking up my Mac? 01:03:25 Caleb-Why can’t I send green bubble RCS/SMS messages from my Mac? Cool Stuff Found 01:07:19 CSF? Apple Creator Studio Logic Pro Pixelmator Pro Final Cut Pro Compressor MainStage Premium content for Pages, Numbers, Keynote, Freeform, Motion and more 01:18:31 MGG 1125 Outtro MGG Monthly Giveaway Bandwidth Provided by CacheFly MGG's CES 2026 Sponsors Pilot Pete's Aviation Podcast: So There I Was (for Aviation Enthusiasts) The Debut Film Podcast – Adam's new podcast! Dave's Business Brain (for Entrepreneurs) and Gig Gab (for Working Musicians) Podcasts MGG Merch is Available! Mac Geek Gab YouTube Page Mac Geek Gab Live Calendar This Week's MGG Premium Contributors MGG Apple Podcasts Reviews feedback@macgeekgab.com 224-888-GEEK Active MGG Sponsors and Coupon Codes List BackBeat Media Podcast Network

In the final installment of this series, Dr. Justin Abbatemarco and Dr. Divyanshu Dubey discuss the latest findings and some non-occupational exposures.  Show citation:  Hinson SR, Gupta P, Paramasivan NK, et al. Neural synaptic vesicle autoimmunity following aerosolized porcine neural tissue exposure: insights into autoimmune inflammatory polyradiculoneuropathy. EBioMedicine. 2025;122:106053. doi:10.1016/j.ebiom.2025.106053 Show transcript:  Dr. Justin Abbatemarco:  Hello, and welcome back. This is Justin Abbatemarco. I'm here with Divyanshu Dubey, discussing his article, Neural Synaptic Vesicle Autoimmunity Following Aerosolized Porcine Neural Tissue Exposure: Insights Into Autoimmune Inflammatory Polyradiculoneuropathy. Div, maybe we could talk about non-occupational exposures? I think many of us don't see this cohort of patients commonly, but I really think this helps inform care, beyond just this specific occupational exposure. What did you guys find in your work? Dr. Divyanshu Dubey:  So, one of the inspirations for this study was driven by the phenotypic characterization of patients who were described in this 2010 paper, which is somewhat similar to some of the patients I currently see in my clinic who don't seem to meet GBS or CIDP criteria. But, based on their MRI findings, based on their CSF studies, the EMG nerve conduction studies, they seem to have this polyradiculoneuropathy presentation, often presenting with asymmetric disease onsets, starting on one leg and then sometimes transitioning to the other side. In some cases, even a non-length dependent pattern with sort of proximal cervical brachial nerve root plexus involvements, which don't really seem to have a blood test, or a biomarker right now. Currently, many of these cases are a diagnosis of exclusion. I was thinking if there's a biomarker that we can identify from this 2006 to 2008 unfortunate event, that might actually help us diagnose these patients. So, once we identified synaptophysin and GAP43 antibodies in the swine abattoir cohort, I went back to our storages of these patients with other inflammatory polyradiculoneuropathy, and found about 5% of these patients from a large cohort of close to 300 patients, did have these antibody biomarkers. Some of these patients had paraneoplastic trigger, where we had patients with neuroendocrine tumors, or hematological malignancies mounting a response to these antibodies. But a good chunk of these patients we did not truly understand, or know what the triggers were. That might be a potential for future studies, as we expand our cohort of these antibodies, as well as study further the phenotypic characterization of these cases. Dr. Justin Abbatemarco: Yeah, there's just so much there, really helping to inform future clinical care outside of this very specific occupational exposure. And then, as we talked about in the podcast, I think really helping to think through how neurological autoimmune diseases develop. So, just really exciting work. We really appreciate you coming on, sharing this. We're excited for how this evolves over the coming years. Dr. Divyanshu Dubey:  Thank you, Justin.  

What happens when offshore rigs become thriving fisheries and why lawmakers are finally paying attention. Kicking off 2026, The Sportsmen's Voice Roundup goes straight to Capitol Hill for a timely update on one of the most important fisheries conservation tools in the country: the Rigs to Reefs program. Fresh off congressional testimony, Chris Horton, CSF's Sr. Director of Fisheries Policy, breaks down what sportsmen and women need to understand about how offshore energy structures are transformed into long-term fish habitat and why that matters for coastal ecosystems and recreational fishing access. This conversation goes beyond politics and into the science. You'll hear how artificial reef structures support real fish productivity, increase biomass, and create ecosystems that simply wouldn't exist without them. Drawing on decades of data and peer-reviewed research, Horton explains why Rigs to Reefs isn't just about attraction, but about sustaining healthy saltwater fisheries for generations of anglers. The episode also tackles common misconceptions around offshore policy, including cost-sharing, industry involvement, and how state fish and wildlife agencies reinvest funds directly into fisheries management and habitat improvement. For anyone passionate about saltwater fishing, coastal conservation, or how federal and state policy shapes the outdoors we enjoy, this is an insider look at how conservation, science, and legislation intersect. Whether you're a Gulf Coast angler, a traveling sportsman, or someone who cares about the future of America's fisheries, this episode provides clarity on why these structures are worth fighting for and how the sporting community can play a role in shaping the outcome. Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Follow The Sportsmen's Voice wherever you get your podcasts: https://podfollow.com/1705085498  Learn more about your ad choices. Visit megaphone.fm/adchoices

In part one of this two-part series, Dr. Stacey Clardy and Drs. Ayush Gupta and Kuntal Sen discuss the key clinical features that should shift suspicion from autoimmune encephalitis or demyelinating disease to monogenic mimics.  Show citation: Gupta A, Sahjwani D, Kahn I, Gombolay GY, Sen K. Monogenic Mimics of Neuroinflammatory Phenotypes in Children and Young Adults: An Evolving Landscape. Neurol Genet. 2025;11(6):e200326. Published 2025 Nov 25. doi:10.1212/NXG.0000000000200326 Show transcript:  Dr. Stacey Clardy: Hi, this is Stacey Clardy from the Salt Lake City VA in the University of Utah. For a two-part podcast series, I've been speaking with Ayush Gupta from the University of Nebraska Medical Center and Kuntal Sen from Children's National Hospital in Washington DC about the monogenic disorders that mimic neuroinflammatory disease that are lurking in all of our clinics just waiting to be diagnosed. Ayush, for the minute, when you're seeing a patient with a presumed autoimmune encephalitis or demyelinating disease, what single cluster of features should instead most strongly push us to think of monogenic mimics at the top of our differential? Dr. Ayush Gupta: So when you are seeing a patient with presumed autoimmune encephalitis or a demyelinating disorder, cluster of features such as earlier onset in terms of age, developmental delays, CSF or imaging finding that's non-concordant with the diagnosis such as a non-inflammatory CSF, a symmetric white matter or deep gray matter involvement and relentless progression despite immunotherapy, these are the red flags where you should stop, seriously consider the possibility of a monogenic disorder and reach out to help from colleagues. Dr. Stacey Clardy: That's a great list, and we get into far more detail in the two-part podcast series. So please listen to both of those and take a read of the neurology genetics review titled Monogenic Mimics of Neuroinflammatory Phenotypes in Children and Young Adults: An Evolving Landscape.

In part one of this two-part series, Dr. Shuvro Roy explains idiopathic normal pressure hydrocephalus (iNPH), its diagnostic challenges, and a study on whether dopamine transporter (DAT) scan results affect gait improvement after a CSF tap test. Show citation: Kim M, Park YH, Song YS, et al. Gait Improvement Following CSF Tap Test in NPH Patients With and Without Striatal Dopaminergic Deficit: A Preliminary Study. Neurol Clin Pract. 2025;15(6):e200549. doi:10.1212/CPJ.0000000000200549

John and Dom introduce guest Brad Nawa (Alamar Biosciences) to explain the NULISA™ platform, an ultra-sensitive platform for protein quantitation that aims to outperform earlier “ultra-sensitive” tools that often didn't translate well in practice. Brad notes the platform is still antibody/content-driven, but differentiates itself by reducing background through a dual-capture purification step and a nucleic-acid barcode/ligation readout, enabling scalable multiplexing (currently ~256-plex, with room to expand). They emphasize the fully automated ARGO™ HT system as a key advantage for minimizing operator variability and supporting strong instrument-to-instrument and lot-to-lot reproducibility. The discussion covers applications including biomarker discovery/monitoring, patient stratification, and PK/PD - especially when sample volume is limited or sensitivity is critical - and use across many matrices (plasma/serum/CSF, tissue lysates, vitreous humor, and dried blood/plasma spots with high recovery reported for most targets). They close by framing the future around building robust datasets for AI/meta-analysis, expanding therapeutic content (notably CNS/neurodegeneration, immunology, and cardiometabolic), and improving cloud software for pathway-level interpretation.“The Weekly Bioanalysis” is a podcast dedicated to discussing bioanalytical news, tools and services related to the pharmaceutical, biopharmaceutical and biomarker industries. Every month, KCAS Bio will bring you another 60 minutes (or so) of friendly banter between our two finest Senior Scientific Advisors as they chat over coffee and discuss what they've learned about the bioanalytical world the past couple of weeks. “The Weekly Bioanalysis” is brought to you by KCAS Bio.KCAS Bio is a progressive growing contract research organization of well over 250 talented and dedicated individuals with growing operations in Kansas City, Doylestown, PA, and Lyon, France, where we are committed to serving our clients and improving health worldwide. Our experienced scientists provide stand-alone bioanalytical services to the pharmaceutical, biopharmaceutical, animal health and medical device industries. 

This episode features a conversation with Jodi Ettenberg, a former lawyer who left her corporate practice in 2008 to travel the world and become a successful travel writer and entrepreneur. Host Janelle Wrigley explores Jodi's unconventional journey from billing 3,000 hours as a first-year attorney in New York to building Legal Nomads, a pioneering travel blog that evolved into a thriving business serving a global community.Janelle and Jodi discuss the challenges of leaving a legal career and practical approaches for lawyers considering major life changes. The conversation takes a profound turn as Jodi shares how a routine medical procedure in 2017 left her with a chronic spinal CSF leak, a debilitating condition that ended her ability to travel and led to a new role as a health advocate.Throughout the episode, Jodi offers candid insights on navigating grief, adapting to change, and the power of community support. Her story highlights the value of intellectual curiosity and the importance of building a life aligned with your values rather than external expectations. This conversation will resonate with anyone facing uncertainty, whether contemplating a career change or managing unexpected life challenges. Alternative careers for lawyers: https://www.legalnomads.com/alternative-careers-lawyers/ To learn more about spinal CSF leak: https://spinalcsfleak.org/

In our final Freedom to Learn episode of the year, Darla Romfo, President and CEO of the Children's Scholarship Fund, joins the podcast to trace the origins of the nation's most influential privately-funded school choice efforts. Darla recounts how CSF's founders, Ted Forstmann and John Walton, sparked a national movement by empowering low-income families with […]

The lymphatic system, or lymphoid system, is one of the components of the circulatory system, and it serves a critical role in both immune function and surplus extracellular fluid drainage.  Components of the lymphatic system include lymph, lymphatic vessels and plexuses, lymph nodes, lymphatic cells, and a variety of lymphoid organs. The pattern and form of lymphatic channels are more variable and complex but generally parallel those of the peripheral vascular system. The lymphatic system partly functions to convey lymphatic fluid, or lymph, through a network of lymphatic channels, filter lymphatic fluid through lymph nodes and return lymphatic fluid to the bloodstream, where it is eventually eliminated. Nearly all body organs, regions, and systems have lymphatic channels to collect the various byproducts that require elimination . Liver and intestinal lymphatics produce about 80% of the volume of lymph in the body. Notable territories of the body that do not appear to contain lymphatics include the bone marrow, epidermis, as well as other tissues where blood vessels are absent. The central nervous system was long considered to be absent of lymphatic vessels until they were recently identified in the cranial meninges. Moreover, a vessel appearing to have lymphatic features was also discovered in the eye. The lymphatic system is critical in a clinical context, particularly given that it is a major route for cancer metastasis and that the inflammation of lymphatic vessels and lymph nodes is an indicator of pathology.  Structure The lymphatic system includes numerous structural components, including lymphatic capillaries, afferent lymphatic vessels, lymph nodes, efferent lymphatic vessels, and various lymphoid organs.  Lymphatic capillaries are tiny, thin-walled vessels that originate blindly within the extracellular space of various tissues. Lymphatic capillaries tend to be larger in diameter than blood capillaries and are interspersed among them to enhance their ability to collect interstitial fluid efficiently. They are critical in the drainage of extracellular fluid and allow this fluid to enter the closed capillaries but not exit due to their unique morphology. Lymphatic capillaries at their blind ends are composed of a thin endothelium without a basement membrane. The endothelial cells at the closed end of the capillary overlap but shift to open the capillary end when interstitial fluid pressure is greater than intra-capillary pressure. This process permits lymphocytes, interstitial fluid, bacteria, cellular debris, plasma proteins, and other cells to enter the lymphatic capillaries. Special lymphatic capillaries called lacteals exist in the small intestine to contribute to the absorption of dietary fats. Lymphatics in the liver contribute to a specialized role in transporting hepatic proteins into the bloodstream. The lymphatic capillaries of the body form large networks of channels called lymphatic plexuses and converge to form larger lymphatic vessels. Lymphatic vessels convey lymph, or lymphatic fluid, through their channels. Afferent (toward) lymphatic vessels convey unfiltered lymphatic fluid from the body tissues to the lymph nodes, and efferent (away) lymphatic vessels convey filtered lymphatic fluid from lymph nodes to subsequent lymph nodes or into the venous system. The various efferent lymphatic vessels in the body eventually converge to form two major lymphatic channels: the right lymphatic duct and the thoracic duct.  The right lymphatic duct drains most of the right upper quadrant of the body, including the right upper trunk, right upper extremity, and right head and neck. The right lymphatic trunk is a visible channel in the right cervical region just anterior to the anterior scalene muscle. Its origin and termination are variable in morphology, typically forming as the convergence of the right bronchomediastinal, jugular, and subclavian trunks, extending 1 to 2 centimeters in length before returning its contents to the systemic circulation at the junction of the right internal jugular, subclavian, and/or brachiocephalic veins.  The thoracic duct, also known as the left lymphatic duct or van Hoorne's canal, is the largest of the body's lymphatic channels. It drains most of the body except for the territory of the right superior thorax, head, neck, and upper extremity served by the right lymphatic duct. The thoracic duct is a thin-walled tubular vessel measuring 2 to 6 mm in diameter. The length of the duct ranges from 36 to 45 cm. The thoracic duct is highly variable in form but typically arises in the abdomen at the superior aspect of the cisterna chyli, around the level of the twelfth thoracic vertebra (T12). The cisterna chyli, from which it extends, is an expanded lymphatic sac that forms at the convergence of the intestinal and lumbar lymphatic trunks extending along the L1-L2 vertebral levels. The cisterna chyli is present in approximately 40-60% of the population, and in its absence, the intestinal and lumbar lymphatic trunks communicate directly with the thoracic duct at the T12 level. As a result, the thoracic duct receives lymphatic fluid from the lumbar lymphatic trunks and chyle, composed of lymphatic fluid and emulsified fats, from the intestinal lymphatic trunk. Initially, the thoracic duct is located just to the right of the midline and posterior to the aorta. It exits the abdomen and enters the thorax via the aortic hiatus formed by the right and left crura of the diaphragm, side by side with the aorta. The thoracic duct then ascends in the thoracic cavity just anterior and to the right of the vertebral column between the aorta and azygos vein. At about the level of the fifth thoracic vertebra (T5), the thoracic duct typically crosses to the left of the vertebral column and posterior to the esophagus. From here, it ascends vertically and usually empties its contents into the junction of the left subclavian and left internal jugular veins in the cervical region. To ensure that lymph does not flow backward, collecting lymphatic vessels and larger lymphatic vessels have one-way valves. These valves are not present in the lymphatic capillaries. These lymphatic valves permit the continued advancement of lymph through the lymphatic vessels aided by a pressure gradient created by vascular smooth muscle, skeletal muscle contraction, and respiratory movements. However, it is important to note that lymphatic vessels also communicate with the venous system through various anastomoses. Lymph nodes are small bean-shaped tissues situated along lymphatic vessels. Lymph nodes receive lymphatic fluid from afferent lymphatic vessels and convey lymph away through efferent lymphatic vessels. Lymph nodes serve as a filter and function to monitor lymphatic fluid/blood composition, drain excess tissue fluid and leaked plasma proteins, engulf pathogens, augment an immune response, and eradicate infection. Several organs in the body are considered to be lymphoid or lymphatic organs, given their role in the production of lymphocytes. These include the bone marrow, spleen, thymus, tonsils, lymph nodes, and other tissues. Lymphoid organs can be categorized as primary or secondary lymphoid organs. Primary lymphoid organs are those that produce lymphocytes, such as the bone marrow and thymus. Bone marrow is the primary site for the production of lymphocytes. The thymus is a glandular organ located anterior to the pericardium. It serves to mature and develop T cells, or thymus cell lymphocytes, in response to an inflammatory process or pathology. As individuals age, both their bone marrow and thymus reduce and accumulate fat. Secondary lymphoid organs serve as territories in which immune cells function and include the spleen, tonsils, lymph nodes, and various mucous membranes, such as in the intestines. The spleen is a purplish, fist-sized organ in the left upper abdominal quadrant that contributes to immune function by serving as a blood filter, storing lymphocytes within its white pulp, and being a site for an adaptive immune response to antigens. The lingual tonsils, palatine tonsils, and pharyngeal tonsils, or adenoids, work to prevent pathogens from entering the body. Mucous membranes in the gastrointestinal, respiratory, and genitourinary systems also function to prevent pathogens from entering the body. Lymph Lymphatic fluid, or lymph, is similar to blood plasma and tends to be watery, transparent, and yellowish in appearance. Extracellular fluid leaks out of the blood capillary walls because of pressure exerted by the heart or osmotic pressure at the cellular level. As the interstitial fluid accumulates, it is picked up by the tiny lymphatic capillaries along with other substances to form lymph. This fluid then passes through the lymphatic vessels and lymph nodes and finally enters the venous circulation. As the lymph passes through the lymph nodes, both monocytes and lymphocytes enter it.  Lymph is composed primarily of interstitial fluid with variable amounts of lymphocytes, bacteria, cellular debris, plasma proteins, and other cells. In the GI tract, lymphatic fluid is called chyle and has a milk-like appearance that is chiefly due to the presence of cholesterol, glycerol, fatty acids, and other fat products. The vessels that transport the lymphatic fluid from the GI tract are known as lacteals. Embryology The development of the lymphatic system is known from both human and animal, especially mouse studies. The lymphatic vessels form after the development of blood vessels, around six weeks post-fertilization. The endothelial cells that serve as precursors to the lymphatics arise from the embryonic cardinal veins. The process by which lymphatic vessels form is similar to that of the blood vessels and produces lymphatic-venous and intra-lymphatic anastomoses, but diverse origins exist for components of lymphatic vessel formation in different regions.  Six primary lymph sacs develop and are apparent about eight weeks post-fertilization. These include, from caudal to cranial, one cisterna chyli, one retroperitoneal lymph sac, two iliac lymph sacs, and two jugular lymph sacs. The jugular lymph sacs are the first to develop, initially appearing next to the jugular part of the cardinal vein. Lymphatic vessels then form adjacent to the blood vessels and connect the various lymph sacs. The lymphatic vessels primarily arise from the lymph sacs through the process of self-proliferation and polarized sprouting.  Stem/progenitor cells play a huge role in forming lymphatic tissues and vessels by contributing to sustained growth and postnatally differentiating into lymphatic endothelial cells. Lymphatic channels from the developing gut connect with the retroperitoneal lymph sac and the cisterna chyli, situated just posteriorly. The lymphatic channels of the lower extremities and inferior trunk communicate with the iliac lymph sacs. Finally, lymphatic channels in the head, neck and upper extremities drain to the jugular lymph sacs. Additionally, a right and left thoracic duct form and connect the cisterna chyli with the jugular lymph sacs and form anastomoses that eventually produce the typical adult form. The lymph sacs then produce groups of lymph nodes in the fetal period. Migrating mesenchyme enters the lymph sacs and produces lymphatic networks, connective tissue, and other layers of the lymph nodes. Function The lymphatic system's primary function is to balance the volume of interstitial fluid and convey it and excess protein molecules into the venous circulation. The lymphatic system is also important in immune surveillance, defending the body against foreign particles and microorganisms. It does so by conveying antigens and leukocytes to lymph nodes, where antigen-primed and targeted lymphocytes and other immune cells are conveyed into the lymphatic vessels and blood vessels. In addition, the system has a role in the absorption of fat-soluble vitamins and fatty substances in the gut via the gastrointestinal tract's lacteals within the villi and the transport of this material into the venous circulation.  Newly recognized lymphatic vessels are visible in the meninges relating to cerebrospinal fluid (CSF) outflow from the central nervous system. Finally, lymphatics may play a role in the clearance of ocular fluid via the lymphatic-like Schlemm canals. Clinical Significance Leaks of lymphatic fluid occur when the lymphatic vessels are damaged. In the abdomen, lymphatic vessel damage may occur during surgery, especially during retroperitoneal procedures such as repairing an abdominal aortic aneurysm. These leaks tend to be mild, and the vessels in the peritoneum and mesentery eventually absorb the lymphatic fluid or chyle. However, when the thoracic duct is injured in the chest, the chyle leak can be extensive. In most cases, conservative care with a no-fat diet (medium chain triglycerides) or total parenteral nutrition is unsuccessful. In most cases, if the injury to the thoracic duct was surgical, a surgical procedure is required to tie off the duct. If the thoracic duct is injured in the cervical region, then inserting a drainage tube and adopting a low-fat diet will help seal the leak. However, thoracic duct injury in the chest cavity usually requires drainage and surgery. It is rare for the thoracic segment of the thoracic duct to seal on its own. In terms of accumulation of chyle in the thorax (i.e., chylothorax), if a patient has an injury to the thoracic duct in the thorax below the T5 vertebral level, then fluid will collect in only the right pleural cavity. If the injury is to the thoracic duct in the thorax above the T5 vertebral level, then fluid will appear in both pleural cavities.   Other Issues The lymphatic system is prone to disorders like the venous and arterial circulatory systems. Developmental or functional defects of the lymphatic system cause lymphedema. When this occurs, the lymphatic system is unable to sufficiently drain lymphatic fluid resulting in its accumulation and swelling of the territory. Lymphedema, this swelling due to the accumulation of lymph, is classified as primary or secondary. Primary lymphedema is an inherited disorder where the lymphatic system development has been disrupted, causing absent or malformed lymphatic tissues. This condition often presents soon after birth, but some conditions may present later in life (e.g., at puberty or later adulthood). There are no effective treatments for primary lymphedema. Past surgical treatments were found to be mutilating and are no longer implemented. The present-day treatment revolves around compression stockings, pumps, and constrictive garments. Secondary lymphedema is an acquired disorder involving lymphatic system dysfunction that may result from many causes, including cancer, infection, trauma, or surgery. The treatment of secondary lymphedema depends on the cause. Oncological and other surgeries may result in secondary lymphedema due to the removal or biopsy of lymph nodes or lymphatic vessels. Non-surgical lymphedema may result from malignancies, obstruction within the lymphatic system, infection, or deep vein thrombosis. In most cases of obstructive secondary lymphedema, the drainage will resume if the inciting cause is removed, although some individuals may need to wear compressive stockings permanently. Also, physical therapy may help alleviate lymphedema when the extremities are involved. There is no absolute cure for lymphedema, but diagnosis and careful management can help to minimize complications. Lymphomas are cancers that arise from the cells of the lymphatic system. There are numerous types of lymphoma, but they are grouped into Hodgkin lymphoma and non-Hodgkin lymphoma. Lymphomas usually arise from the malignant transformation of specific lymphocytes in the lymphatic vessels or lymph nodes in the gastrointestinal tract, neck, axilla, or groin. Symptoms of lymphoma may include night sweats, fever, fatigue, itching, and weight loss. Cancers originating outside of the lymphatic system often spread via the lymphatic vessels and may involve regional lymph nodes serving the impacted organs or tissues. Lymphadenitis occurs when the lymph nodes become inflamed or enlarged. The cause is usually an adjacent bacterial infection but may also involve viruses or fungi. The lymph nodes usually enlarge and become tender. Lymphatic filariasis, or elephantiasis, is a very common mosquito-borne disorder caused by a parasite found in tropical and subtropical areas of the world, including Africa, Asia, the Pacific, the Caribbean, and South America. This condition involves parasitic microscopic nematodes (roundworms) that infect the lymphatic system and rapidly multiply and disrupt lymphatic function. Many infected individuals may have no outward symptoms, although the kidneys and lymphatic tissues may be damaged and dysfunctional. Symptomatic individuals may present with disfigurement caused by significant lymphedema and elephantiasis (thickening of the skin, particularly the extremities). The parasite may also cause hydrocele, an enlargement of the scrotum due to the accumulation of fluid, which may result from obstruction of the lymph nodes or vessels in the groin. Individuals presenting with symptoms have poorly draining lymphatics, often involving the extremities, resulting in huge extremities and marked disability. Lymphatic filariasis is the most common cause of disfigurement in the world, and it is the second most common cause of long-term disability.  (credits: NIH)

In this episode of the NCS Podcast Hot Topics series, host Richard Choi, DO, FNCS, speaks with Katharina Busl, MD, MS, FNCS, division chief of neurocritical care at the University of Florida and assistant editor for Neurocritical Care journal. They explore new research on cerebrospinal fluid (CSF) clearance after aneurysmal subarachnoid hemorrhage. They also discuss the study Prospective Trial of Cerebrospinal Fluid Filtration After Aneurysmal Subarachnoid Hemorrhage: The Lumbar Catheter Extension (PILLAR XT) Trial, which evaluates a dual-lumen intrathecal catheter designed to filter CSF and accelerate removal of red blood cells and inflammatory byproducts. Their conversation highlights the rationale behind CSF drainage, how prior work like the Early Drain trial shaped the field, and what this early-phase device trial reveals about feasibility, safety, and reductions in CSF RBC and protein levels. Dr. Bussel and Dr. Choi also touch on implementation challenges and the need for larger trials before this approach can move into broader clinical use. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of “Answers From the Lab,” host Bobbi Pritt, M.D., chair of the Division of Clinical Microbiology at Mayo Clinic, is joined by William Morice II, M.D., Ph.D., president and CEO of Mayo Clinic Laboratories, to discuss recent news about Protecting Access to Medicare Act (PAMA) reform. Then, Dr. Pritt welcomes Trish Simner, Ph.D., a clinical microbiologist at Mayo Clinic, for an in-depth conversation about metagenomics. PAMA reform update and new RESULTS Act (00:30): Hear about options under consideration for PAMA reform, including the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act.When cerebrospinal fluid (CSF) metagenomics benefit patient care (06:04): Explore how CSF metagenomics work and when it is appropriate to use this advanced diagnostic tool in clinical practice.Advancement and innovation in metagenomics (18:15): Discover how recent and upcoming innovation is expanding metagenomic testing capabilities. Note: Information in this post was accurate at the time of its posting.ResourcesAnswers From the Lab podcast: Developments for LDT Regulation and Laboratory Reimbursement: Bill Morice, M.D., Ph.D.Metagenomics: Identifying elusive pathogenic microorganisms

Major wins for wildlife management and new hunting opportunities highlight a pivotal week for outdoorsmen. This week's Sportsmen's Voice Roundup covers one of the most encouraging conservation wins of the year. Fred opens with a deep dive into Washington's wolf-management shakeup, where a court dismissed a lawsuit that blocked lethal removal authority during active livestock depredations. CSF's Assistant Manager, Northwestern States Marie Neumiller joins the show with boots-on-the-ground insight into wolf behavior, non-lethal deterrents, and how lawsuits can undermine science-based wildlife management. The team provides clarity on wolf depredation thresholds, why lethal removal is necessary no matter what the anti-hunters say, and how litigation disrupts effective predator control for ranchers and wildlife managers alike.   From there, we shift east to Maryland, where CSF's own Kaleigh Leager, Assistant Manager, Mid-Atlantic States has been appointed to the Migratory Game Bird Advisory Committee, an influential body shaping waterfowl hunting regulations and habitat conservation across the Atlantic Flyway. Learn why this Committee matters, what species are directly affected, and how sportsmen's voices influence state-level gamebird policy.   We then head to Wisconsin for an update on the Knowles-Nelson Stewardship Program, a cornerstone conservation funding mechanism now fighting for reauthorization. Hear how land access, habitat improvement, and long-term investment in hunting and fishing opportunities hinge on the outcome.   Finally, we wrap with a look at surging black bear hunting opportunities across the Southeast. From Florida to Louisiana to North Carolina, thriving bear populations and science-based management are opening new doors for hunters seeking adventure, wild game, and conservation impact.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Follow The Sportsmen's Voice wherever you get your podcasts: https://podfollow.com/1705085498  Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, we welcome neuroscientist Michele Bellesi from the University of Camerino to explore the fascinating world of glial cells and their dynamic role in sleep. Michele guides us through the four types of glial cells:Astrocytes: Regulators of synaptic function and help form the blood brain barrier (BBB)Oligodendrocytes: Crucial for myelination and fast signal transmissionMicroglia: The brain's immune sentinels, important for responding to infection and injury as well as shaping the synaptic landscapeEpendymal Cells: Involved in cerebrospinal fluid (CSF) production and CFS movement around the brainWe dive into how each of these cells types behaves differently across wake, sleep and sleep deprivation and the impacts on each cell types function.Find out more about Michele's work here and see relevant papers below.The role of sleep and wakefulness in myelin plasticity, 2019, GliaSleep loss promotes astrocytic phagocytosis and microglial activation in mouse cerebral cortex, 2017, Journal of Neuroscience Effects of sleep and wake on astrocytes: clues from molecular and ultrastructural studies, 2015, BMC BiologyCheck out our NaPS website to find out more about the podcast, our research and events. This recording is the property of the Sleep Science Podcast and not for resale.

Dr. Jay Fisher is back on PEM Rules to discuss his experience with Bacterial Meningitis, a rare (and terrible) condition that is high on my list of "I Never Want to Miss It". Here are the articles Jay discussed: References Clinical Features Suggestive of Meningitis in Children:A Systematic Review of Prospective Data. Pediatrics 2010;126(5);952-960. https://pubmed.ncbi.nlm.nih.gov/20974781/ Bulging fontanelle in febrile infants as a predictorof bacterial meningitis. European Journal of Pediatrics (2021) 180:1243–1248. https://pubmed.ncbi.nlm.nih.gov/33169238/ Here is the link to the picture of the CSF of the patient discussed in the episode.  https://pemrules.com/wp-content/uploads/2024/12/csf.png  

From striped bass policy to black bear hunting, Fred Bird breaks down this week's biggest wins for America's sportsmen. New Hampshire Governor Kelly Ayotte officially joins the Governor's Sportsmen's Caucus, continuing the state's long tradition of leadership in defending hunting and angling heritage. Fred also spotlights CSF's new Rocky Mountain States Coordinator, Nate Serlin, and his role working with the Legislative Sportsmen's Caucuses in Colorado, Idaho, Montana, New Mexico, and Wyoming. On the fisheries front, the Atlantic States Marine Fisheries Commission decides to maintain striped bass regulations, averting unnecessary closures for thousands of saltwater anglers. Down south, Florida's outdoor community celebrates major conservation wins, from saving the Rodman Reservoir bass fishery to reinstating a science-based black bear hunt. Fred also covers how the U.S. Senate voted to uphold science-based wildlife management, defeating an anti-hunting proposal targeting owl conservation, and explains why access without habitat is meaningless for hunters and trappers nationwide. If you care about how policy affects the woods, waters, and wildlife you love, this is your weekly must-listen briefing from the front lines of conservation.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Follow The Sportsmen's Voice wherever you get your podcasts: https://podfollow.com/1705085498  Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome to the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. Following the 2025 Alzheimer's Association International Conference (AAIC), Rebecca Edelmayer, PhD, outlines the Alzheimer's Association's first clinical practice guidelines for using blood-based biomarkers (BBMs) in the diagnostic workup of suspected Alzheimer's disease within specialized care. She explains the guideline mission, how tests were evaluated for accuracy, and when BBMs should serve as triage versus confirmatory tools relative to CSF and PET. Edelmayer details current scope limits (cognitively impaired patients in specialty settings), cautions against overextending to primary care or unimpaired populations, and previews the education roll-out—executive summaries, micro-learning modules, and shared decision-making resources. She closes with research priorities: stronger peer-reviewed reporting, broader validation across diverse populations and settings, and building an equitable pathway that leverages BBMs to speed accurate diagnosis and treatment access. Looking for more Alzheimer & dementia discussion? Check out the NeurologyLive® Alzheimer & dementia clinical focus page. Episode Breakdown: 1:05 – Understanding the purpose and mission behind new blood-based biomarker guidelines 2:05 – Key recommendations and defining triage vs confirmatory blood-based biomarker use 3:15 – Clinical precautions and where blood-based biomarkers are appropriate today 5:30 – Neurology News Minute 7:45 – Educating clinicians on implementing BBMs in specialty care 10:15 – Research priorities to strengthen evidence and ensure equity The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: FDA Accepts New Drug Application for Tau PET Imaging Agent MK-6240 in Alzheimer Disease B-Cell Modulator Obexelimab Shows Pronounced Relapse Reduction in Phase 2 MoonStone Trial Subcutaneous Efgartigimod Shows Efficacy in Phase 2 ALKIVIA, Phase 3 ADAPT SERON Trials Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

First, The Indian Express' Deeptiman Tiwary talks about Prashant Kishor's Jan Suraaj party and how the political-analyst-turned-politician is trying to distinguish himself from others ahead of the upcoming Bihar polls.Next, The Indian Express' Anjali Marar explains the cloud-seeding method that the Delhi government hopes will help reduce pollution, and why experts believe it's a flawed technique (18:54).And finally, we bring you an update on the case involving two Australian cricketers who were sexually harassed in Indore last week (29:44).Hosted by Shashank BhargavaProduced by Shashank Bhargava and Ichha SharmaEdited and mixed by Suresh PawarAdditional Links:1) CSF |  Green Shoots of Progress for Uttar Pradesh2) CSF | Academic and Governance Inputs for NIPUN Bharat Mission3) CSF |  The need for better Public Disclosure in schools4) CSF | The evolving space for AI in Education

Crowd-Sourced Funding (CSF) Equity Raising: a real, underused pathway for SMEs – and a powerful advisory opportunity for your firm. In this episode of Accountants Minute Podcast, Peter Towers busts the myth that only unlisted public companies can raise via CSF, explains the ASIC-licensed intermediary model, and shows how accountants, bookkeepers and advisors can prepare SME clients to raise up to $5M without a prospectus. You'll learn where firms add the most value – investment-readiness (plans, budgets, cashflow forecasts, governance), crafting the CSF Offer Document, and converting post-raise support into ongoing Virtual CFO work. You can also access our podcast on: Amazon Music Apple Podcasts Audible Spotify YouTube

Tumor components and immune response indicators can be found in cerebrospinal fluid, or CSF, when someone has a brain tumor, in a new test developed by Chetan Bettagowda, director of neurosurgery at Johns Hopkins and one of the test's developers.  … Cerebrospinal fluid may hold the keys to brain cancer identification and treatment, Elizabeth Tracey reports Read More »

Your brain and spinal cord are floating in something called cerebrospinal fluid, or CSF, and when brain tumors develop they shed cells and cellular components into this fluid. A new test developed by director of neurosurgery Chetan Bettegowda at Johns … Cerebrospinal fluid can tell lots about brain tumors, Elizabeth Tracey reports Read More »

Testing a fluid known as cerebrospinal fluid, or CSF, found surrounding the brain and spinal cord, reveals a lot about brain tumors and the immune response to them. Johns Hopkins neurosurgery department director Chetan Bettegowda and test developer says this … Can a new test of cerebrospinal fluid be used for many diseases of the brain and spinal cord? Elizabeth Tracey reports Read More »

In today's episode, Dr. Monica Gray and Dr. Pradip Kamat sit down with neurosurgeon Dr. Neal Laxpati, MD, PhD, to chat about intracranial pressure (ICP) monitoring in pediatric critical care. Using real case studies, they dive into how and when to use external ventricular drains (EVDs) and ICP bolts, walking listeners through setup, potential risks, and everyday challenges. The group discusses device complications, ways to prevent infections, how to interpret waveforms, and shares practical bedside tips. It's a must-listen for intensivists looking for hands-on advice and key insights to help optimize care for kids with brain injuries or hydrocephalus.Show Highlights:Pediatric critical care unit (PCU) case discussionsIntracranial pressure (ICP) monitoring in pediatric patientsCase studies involving a 10-year-old girl with diffuse midline glioma and a 16-year-old male with a ruptured arteriovenous malformation (AVM)Cerebrospinal fluid (CSF) physiology and its role in ICP managementTypes of ICP monitoring devices: external ventricular drains (EVDs) and intraparenchymal monitorsIndications and complications associated with ICP monitoringInterpretation of ICP waveforms and their clinical significanceManagement strategies for elevated ICP and CSF drainageRisks and challenges of ICP monitoring, including infection and device malfunctionImportance of interdisciplinary communication and meticulous bedside care in pediatric critical care settingsReferences:Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 118. Traumatic brain injury. Kochaneck et al. Page 1375 -1400Rogers textbook:Reference 1: Forsyth RJ, Parslow RC, Tasker RC, Hawley CA, Morris KP; UK Paediatric Traumatic Brain Injury Study Group; Paediatric Intensive Care Society Study Group (PICSSG). Prediction of raised intracranial pressure complicating severe traumatic brain injury in children: implications for trial design. Pediatr Crit Care Med. 2008 Jan;9(1):8-14. doi: 10.1097/01.PCC.0000298759.78616.3A. PMID: 18477907.Reference 2: Appavu B, Burrows BT, Foldes S, Adelson PD. Approaches to Multimodality Monitoring in Pediatric Traumatic Brain Injury. Front Neurol. 2019 Nov 26;10:1261. doi: 10.3389/fneur.2019.01261. PMID: 32038449; PMCID: PMC6988791.

As part of our ongoing collaboration with Central Square Foundation, we are excited to bring to you the fourth episode of our five part series where we talk about the evolving landscape of AI in Education.The National Education Policy 2020 marks a bold shift in how we think about technology in learning. It envisions a future where students build not just digital literacy, but also computational thinking and AI fluency — and where teachers are empowered with the tools, training, and support to integrate AI into their curriculums meaningfully and responsibly. To understand how this is being implemented, we'll be joined by Gouri Gupta, Sr. Project Director of EdTech who leads CSF's work in EdTech and AI and Professor Balaraman Ravindran, Head, Wadhwani School of Data Science & AI (WSAI), IIT Madras who is one of India's top AI researchers and has helped shape India's AI policy framework and currently advises the Reserve Bank of India on the uses of AI in finance. Hosted and produced by Niharika NandaEdited and mixed by Suresh PawarLinks to the previous episodes of our series with CSF:Episode 1Episode 2Episode 3

Send us a textA newborn with higher pTau217 than an adult with Alzheimer's—what would that mean for how we detect, define, and treat dementia? We dive into a startling new finding that reframes tau phosphorylation as a dynamic, reversible process rather than a one-way street. From the costs and tradeoffs of PET scans and CSF analysis to the promise of new blood tests, we lay out how clinicians navigate biomarkers and why context matters. If babies and even hibernating animals can toggle tau safely, we might be looking at a new horizon for Alzheimer's research—one that prioritizes regulation over blunt suppression and respects the difference between signals and symptoms.Then we turn to our dogs and a different kind of brain science: play that looks a lot like behavioral addiction. In a study of high-drive pets, some dogs pursued play so intensely they ignored food and struggled to settle once the toy disappeared. The kicker? It's not the toy—it's the play. We unpack how anticipation and reward loops shape behavior, why shepherds and terriers tend to lean in hard, and how to channel that energy with structured games, clear start/stop cues, and decompression routines that protect both joy and well-being.Our guest, Dr. Nancy Kay—veterinarian and small animal internal medicine specialist—brings practical wisdom to family life with pets. She explains how to choose a dog that truly fits a home with kids, why supervision and respect rules beat wishful thinking, and how to steer clear of puppy mills and dog auctions with two simple safeguards: never buy from pet stores and never purchase sight unseen. We talk about her middle-grade novel, “A Dog Named 647,” her advocacy guide “Speaking for Spot,” and the unforgettable cases that come with a life in medicine—from swallowed treasures to high-stakes rescues. It's science that matters, compassion that lasts, and stories that stick.Enjoy the conversation? Follow, share with a friend, and leave a quick review to help more curious listeners find the show.Dr. Nancy's Links:A Dog Named 647Her WebsiteOur links!Support the showFor Science, Empathy, and Cuteness!Being Kind is a Superpower.https://twitter.com/bunsenbernerbmd

Episode 204: Adult Pneumococcal Vaccines in 2025.  Luz Perez (MSIV) presents all the available pneumococcal vaccines for adults. Dr. Arreaza guides the discussion about what to do with adults who have previously received pneumococcal vaccines. Written by Luz Perez, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Today we're answering a clinic classic: Which pneumococcal vaccine should my adult patient get—and when? This is an update of episode 90.Why pneumococcal vaccines matter?Pneumococcal vaccines prevent infections caused by the bacteria Streptococcus pneumonia. These bacteria can cause serious infections like pneumonia, meningitis, and bacteremia. In 2017, the CDC reports that there were more than 31,000 cases of pneumococcal infections and 3,500 deaths from invasive pneumococcal disease. Children are vaccinated in early childhood, before age 5, with PCV15 or PCV 20, at the age of 2, 4, 6 months and a last dose around 12-15 months. Why do we vaccinate adults?Adults are vaccinated because they're at higher risk of getting pneumococcal disease or of having worse outcomes if they do. Vaccines are important because they protect these at-risk patients and reduce the spread of infections among communities. What are the available vaccines? PCV vs PPSV.There are two pneumococcal vaccines used in practice: a polysaccharide vaccine (PPSV) and a conjugate vaccine (PCV). Both protect by targeting capsular polysaccharides from pneumococcal serotypes most often responsible for invasive disease. In simple terms, these vaccines target a part of the bacteria “coating” and create antibodies or proteins that protect the body when the strep enters the body. PPSV (polysaccharide): PPSV is made from purified pieces of the pneumococcal capsule or coating. The current vaccine PPSV23 (Pneumovax®) covers 23 serotypes (or strains) that were the leading cause of pneumococcal infections in the 1980s. PCV (conjugate): Pneumococcal conjugate vaccines (PCVs) take capsular polysaccharides from the bacterium and chemically link them to a carrier protein, which changes and strengthens the immune response. Current PCVs come in four versions: PCV13 (Prevnar 13)PCV15 (Vaxneuvance)PCV20 (Prevnar 20)PCV21 (Capvaxive) The number indicates the amount of pneumococcal capsule types covered by each vaccine. PCV21 was designed around adult disease patterns and covers many serotypes currently driving invasive disease in adults. However, it does not include serotype 4, but this serotype is covered by the PCV20 and PCV15.Who should be vaccinated? In 2024, the United States Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) updated their recommendations on Pneumococcal vaccinations for adults. Their recommendations are: Everyone 50 years or olderAdults age 19–49 with risks: chronic lung/liver disease, heart failure, diabetes; CSF leak or cochlear implant; immunocompromised states (e.g., HIV, hematologic malignancy, CKD/nephrotic syndrome); functional/anatomic asplenia.Patients with history of prior invasive pneumococcal disease: still vaccinate. What vaccine should be given for adults that have never received the Pneumococcal vaccine?For eligible adults with no prior pneumococcal vaccines, there are three choices:PCV21 oncePCV20 oncePCV15 now, followed by PPSV23 later, usually 1 year; 8 weeks if immunocompromised, CSF leak, or cochlear implant.PCV 20 or PCV21 seem more convenient. Once and done. If available, PCV21 is a great one-and-done pick for most adults because it's tailored to current adult serotypes.Serotype 4 caveat: If your patient is at higher risk for serotype 4 disease—think Navajo Nation, or folks in the Western US/Canada with substance use disorders or experiencing homelessness—choose PCV20 (or PCV15 followed by PPSV23 if PCV20 isn't available).What if the patient already received a Pneumococcal vaccine in the past?Plan depends on which vaccine they received and when.PPSV23 only: give PCV21 ≥1 year later (or PCV20 if serotype-4 risk or PCV21 unavailable).PCV10 or PCV13 only: give PCV21 (or PCV20 if PCV21 unavailable) ≥1 year later. If a PCV is not available, discuss PPSV23 now vs waiting until PCV is available.If patient receives PPSV23 now will need to return ≥1 year later to receive a PCV vaccine, and no more vaccines are needed after that.Is it safe to administer the Pneumococcal vaccine with other vaccines?Coadministration is fine with other non-pneumococcal vaccines, as long as we use different syringes and sites. Data support same-day administration of PPSV23 + influenza, and PCV20 with influenza or mRNA COVID-19 vaccines.Some patients are hesitant to receive vaccines, Are there side effects and contraindications to the vaccine?Local reactions are most common: pain/tenderness; swelling/induration (~20%); redness (~15%). Some people “baby” the arm for a couple of days. These typically resolve in 3–4 days; NSAIDs and warm compresses help.Systemic symptoms: fatigue, headache, myalgias/arthralgias, chills; fever ≥38°C is uncommon (

The Glymphatic System is the brain's newly discovered waste clearance system. It acts like a highly specialized lymphatic system for the central nervous system, flushing out toxins and metabolic waste, including proteins like amyloid-beta, which are associated with Alzheimer's disease. The glymphatic system is most active during sleep and is powered by the rhythmic movement of cerebrospinal fluid (CSF).Chiropractic care, particularly through its influence on the spine and nervous system, is theorized to have a direct impact on the function and efficiency of this vital brain cleansing process.1. Chiropractic Care and CSF FlowChiropractic adjustments aim to restore proper motion and alignment to the vertebrae, particularly in the upper neck (cervical spine). This area is crucial because:Dural Tension: Misalignment in the upper neck (subluxations) can create tension in the surrounding connective tissues, which are continuous with the dura mater (the membrane covering the brain and spinal cord). This tension can mechanically impede the optimal flow of Cerebrospinal Fluid (CSF).Optimal Fluid Dynamics: Since the glymphatic system relies on the pulsatile flow of CSF to exchange fluid and clear waste, ensuring the craniocervical junction (where the head meets the neck) is functioning optimally is essential. By reducing tension and restoring alignment, chiropractic adjustments may help maintain the natural, unimpeded "pumping" action required for efficient CSF and, thus, glymphatic movement.2. Impact on Autonomic Nervous System BalanceChiropractic care is well-known for its ability to influence the Autonomic Nervous System (ANS), which controls involuntary bodily functions.The Vagus Nerve: The upper cervical spine is close to the brainstem and key areas of the nervous system, including the vagus nerve. Adjusting this area can help shift the ANS from a state of "fight or flight" (sympathetic dominance) toward a state of "rest and digest" (parasympathetic dominance).Better Sleep, Better Clearance: The glymphatic system is most active during deep, restorative sleep. By promoting a parasympathetic state, chiropractic adjustments can help patients achieve deeper, higher-quality sleep, directly enhancing the hours dedicated to crucial brain detoxification.3. Benefits for Overall Brain HealthBy optimizing CSF and supporting the nervous system, the benefits of combining chiroThis podcast welcomes your feedback here are several ways to reach out to me. If you have a topic you would like to hear about send me a message. I appreciate your listening. Dr. Brian Mc Kayhttps://twitter.com/DarienChiro/https://www.facebook.com/ChiropractorBrianMckayhttps://chiropractor-darien-dr-brian-mckay.business.sitehttps://podcasts.apple.com/us/podcast/not-just-chiropractor-for-stamford-darien-norwalk-new/id1503674397?uo=4Core Health Darien-Dr.Brian Mc Kay 551 Post RoadDarien CT 06820203-656-363641.0833695 -73.46652073GMP+87 Darien, Connecticuthttps://youtu.be/WpA__dDF0O041.0834196 -73.46423349999999https://darienchiropractor.comhttps://darienchiropractor.com/darien/darien-ct-understanding-pain/Find us on Social Mediahttps://chiropractor-darien-dr-brian-mckay.business.site https://www.youtube.com/channel/UCNHc0Hn85Iiet56oGUpX8rwhttps://docs.google.com/spreadsheets/d/1nJ9wlvg2Tne8257paDkkIBEyIz-oZZYy/edit#gid=517721981https://goo.gl/maps/js6hGWvcwHKBGCZ88https://www.youtube.com/my_videos?o=Uhttps://www.linkedin.com/in/darienchiropractorhttps://www.facebook.com/ChiropractorBrianMckayhttps://sites.google.com/view/corehealthdarien/https://sites.google.com/view/corehealthdarien/home

As part of our ongoing collaboration with Central Square Foundation, we are here with the third episode of our five part series where we talk about public disclosure of school learning quality data.Usually, when parents assess schools for their children, they focus on non-academic factors like infrastructure and school facilities. But they do not have access to information regarding the most important factor that is student learning quality. The National Education Policy 2020 places a strong emphasis on public disclosure of school performance. To understand how is this reform is being implemented, we'll be joined by two guests who have been working hard towards bringing this change, Kapil Khurana, Associate Director for School Governance at CSF and A.K. Modh Patel, Additional Director, GCERT, Gujarat who is leading Gujarat's effort to disclose school learning quality data through the School Quality Assessment and Assurance Framework (SQAAF).Hosted and produced by Niharika NandaEdited and mixed by Suresh PawarLink to the first and second episode of our series with CSF:Episode 1Episode 2

Celebrate hunting and fishing traditions while exploring the latest conservation victories and outdoor legislative battles.   Hunting and fishing aren't just pastimes—they're the backbone of conservation in America. In this episode of Sportsmen's Voice, we dive into the significance of National Hunting and Fishing Day and the powerful reminder it brings about the role sportsmen play in wildlife management. You'll hear why state proclamations and bipartisan support matter more than ever for protecting our sporting heritage.   We break down Michigan's critical hunting license restructuring and what it means for the future of conservation funding. From there, we highlight the leadership of CSF's Senior Vice President, Taylor Schmitz and his recognition for advancing pro-sportsman policies, giving listeners an inside look at how strong advocacy shapes the outdoor world.   The discussion also previews the upcoming 22nd Annual NASC Sportsman-Legislator Summit, a gathering where the future of hunting and fishing legislation takes center stage. And if you're dreaming about big game, don't miss our look at expanding elk hunting opportunities in Alaska, proof that smart wildlife management benefits both hunters and ecosystems.   Whether you're a seasoned waterfowl hunter, an elk enthusiast, or a weekend angler, this episode equips you with the knowledge and context to stay informed, stay engaged, and keep our outdoor traditions alive.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Follow The Sportsmen's Voice wherever you get your podcasts: https://podfollow.com/1705085498  Learn more about your ad choices. Visit megaphone.fm/adchoices

What if we could detect Alzheimer's disease before the first memory fades? In this powerful episode of Med Tech Gurus, Dr. Maria-Magdalena Patru, MD, PhD—who leads the neurology medical team at Roche Diagnostics US—explains how early diagnosis is being radically transformed through CSF and blood-based biomarker innovations. With Alzheimer's affecting over 7 million Americans, Dr. Patru outlines how new guidelines, improved reimbursement, and diagnostic advances are helping clinicians identify the disease earlier—when treatments can still preserve cognition. She also shares how her personal connection to Alzheimer's drives her mission and offers advice to innovators navigating regulatory and clinical pathways. If you're building diagnostics or working on access-to-care challenges, this is a must-listen. https://www.medtechgurus.com https://diagnostics.roche.com/us/en/products/product-category/neurology/alzheimers-disease.html  

Normal pressure hydrocephalus, where fluid called CSF builds up in the brain, is fairly common with aging, and has been treated with something called a shunt that diverts the excess fluid to the abdomen. Now a study by Mark Luciano, … Shunts do work for a condition where fluid builds up in the brain, Elizabeth Tracey reports Read More »

The singer Billy Joel recently announced he has normal pressure hydrocephalus, or NPH, a condition where fluid builds up in the brain and may cause a host of problems. Mark Luciano, a neurosurgeon and head of the CSF disorders group … Fluid in the brain known as hydrocephalus is fairly common with aging, Elizabeth Tracey reports Read More »

As part of our ongoing collaboration with Central Square Foundation, we are excited to bring to you the second episode of our five part series where we talk about the transformative journey of the NIPUN Bharat Mission.It has been four years since the launch of the Mission and for the first time in two decades we are seeing learning improvements among children. In this episode, we explore how the program has made significant strides in improving literacy and numeracy levels of students in Grades 1-3 across the country. And to get a deeper insight into the progress behind this Mission, we're joined by Parthajeet Das, Project Director for FLN, at CSF and Sambhrant Srivastava, Associate Director for FLN, who have been closely working with state departments of education of Haryana, Madhya Pradesh,Uttar Pradesh, Telangana, Assam, Punjab and Odisha, among other states.Hosted and produced by Niharika NandaEdited and mixed by Suresh PawarLink to the first episode of our series with CSF:Episode 2

Vinod Karate is Project Director for State Reform at the Central Square Foundation where he helps drive India's landmark NIPUN Bharat Mission to ensure every child can read, write, and count by age ten. From an early career in investment banking to shaping one of the world's largest foundational learning reforms, Vinod's journey bridges sharp strategy with deep community engagement. In this episode, Vinod shares how India is rethinking the very foundations of schooling and how CSF partners with states to design and scale reforms that align with India's NIPUN Bharat goals. He unpacks CSF's three-phase approach to state reform: strengthening teacher capacity, redesigning governance around learning outcomes, and building political and administrative coalitions, which helps make large-scale change possible. Drawing on his experience in Uttar Pradesh, Madhya Pradesh, and Haryana, Vinod illustrates how reform really takes root on the ground. He explains how structured pedagogy, sustained teacher mentoring, and real-time data and assessment can translate policy into daily classroom practice, and how seizing windows of political alignment, unlocking budgets, and shifting decision-making from state capitals to districts ensures that change is owned and sustained at the local level. Grounded in evidence, this episode offers a clear, actionable roadmap for strengthening foundational learning and creating education systems that sustain reform and deliver lasting results for every child.

In this episode of the Trauma and Burn Anesthesia Series, we examine traumatic brain injury, the leading cause of trauma-related death in the U.S., affecting over a million people annually and leaving millions with long-term disability. We discuss the importance of the Glasgow Coma Scale, the types of primary injuries such as subdural, epidural, and intraparenchymal hematomas as well as diffuse axonal injury, and how these lead to increased intracranial pressure, herniation, and neurological decline. We explore secondary brain injury from hypotension, hypoxemia, hypercapnia, and hyperthermia, emphasizing the need to maintain adequate perfusion and oxygenation while balancing damage control resuscitation. Key management strategies include hyperosmolar therapy, ICP monitoring, CSF drainage, hyperventilation, mannitol use, steroids, seizure and infection prophylaxis, and cautious fluid therapy. We also cover practical intraoperative considerations, avoiding excessive anesthetics, carefully managing CSF drains, and adjusting ventilation, while highlighting the added complexity when TBI patients also present with massive hemorrhage.Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:

Learn about facial injury red flags, CSF identification, EAP essentials, and return-to-play guidelines for athletes from Dr. Rehal Bhojani. Q: What are the red flags for hematomas? A: Protocols from SCAT6 and other guidelines for hematomas or hemorrhages emphasize watching for loss of consciousness (LOC), altered mental status, and vomiting. Quickly identify these signs to avoid missing late concussions or other critical issues. Ensure the mechanism of injury (MOI) aligns with the trauma; diagnosis is challenging if it doesn't. Q: How can CSF be identified, and what is the "halo sign" red flag? A: The halo sign, also known as the ring sign, remains the best indicator for identifying cerebrospinal fluid (CSF). CSF is distinct: it has a clear-to-mucous color, is super thin, lighter than water, and does not mix with other fluids. For instance, a soccer player initially diagnosed with a concussion showed a bloody nose and consistent halo sign post-game, necessitating immediate emergency room referral. Q: What essential elements should be added to an Emergency Action Plan (EAP)? A: EAPs are becoming more comprehensive, focusing on three key areas. First, ensure resource accessibility by including contacts for ENTs, dentists, and eye doctors. Second, review the EAP regularly, two to three times a year, rather than just annually, using past injury knowledge to proactively improve it. Third, if using AI to draft EAPs, meticulously verify all listed resources. Q: What items should be included in kits for eye and tooth injuries? A: For eye and tooth injuries, kits should include 4x4 gauzes, an otoscope, a "Save a Tooth" system, eyedrops, nasal tampons, and Afrin. Physician-approved medications should also be added, along with an ENT kit, which is available online. Q: What are the risks and benefits of athletic trainers performing sutures on the field? A: On-field suturing depends on the location and type of laceration, with the cause (e.g., metal object) being crucial due to potential tetanus considerations. Athletes often return to play the same day with sutures. For facial lacerations, specific types and sizes of sutures are used, but caution is advised near the eye. Eyebrows and the skull are generally suitable for suturing if no underlying fracture exists. Control bleeding and inform athletes of the risks associated with playing with sutures; safety is paramount. Q: When can athletes return to play after tooth injuries? A: For primary (baby) teeth, if no secondary tooth injury is suspected, return to play (RTP) is generally straightforward. However, secondary tooth injuries involving complex factors can lead to lasting effects. It is important to document whether the injury involves primary versus permanent teeth. For younger children, involve parents to understand the mechanism of injury and the potential for future crown and root fractures. Q: What current sports medicine trends should recent graduates be aware of or learn in the classroom? A: Sports medicine is constantly evolving, with increased pressure for accurate decision-making. Recent graduates need to be proficient in current literature and comfortable with shared decision-making and escalating care. As athletic trainers often serve as primary sports medicine providers, they require broad skills across various domains. Q: How can these emerging sports medicine competencies be effectively taught? A: Teaching these competencies is challenging due to the need for comprehensive exposure. Educational methods vary by setting, and the field has expanded significantly. Training provides a broad scope, so it's important not to be narrow-minded. Past experiences remain relevant, and post-training, continuous reading and skill refinement are crucial. In a controlled educational environment, students should learn as much as possible, as quickly as possible, to prepare for real-world practice.

Hunting, fishing, and outdoor access face new legislative battles—here's what every sportsman should know.   In this episode, the Congressional Sportsmen's Foundation team breaks down the latest updates shaping hunting, fishing, and outdoor conservation policy at both the state and federal levels.   First, Taylor Schmitz dives into recent public lands legislation, explaining how new proposals could impact hunters, anglers, and outdoor recreation. He highlights the fight to remove harmful language from a reconciliation package, stresses the dangers of selling federal public lands, and shares why community engagement is key to protecting access for future generations.   Next, Chris Horton covers Q3 updates in the fisheries and boating sector, including the reauthorization of the Sport Fish Restoration and Boating Trust Fund and the latest movement on the SHARKED Act. We discuss how shark depredation is affecting saltwater anglers, why conservation strategies must balance fisheries management with angler access, and how visual storytelling is being used to highlight marine conservation issues.   Finally, John Culclasure brings an update on federal and state forest policy, unpacking the challenges of wildfire threats, roadless rule restrictions, and timber sales. He shares highlights from the American Forest Congress, emphasizes the importance of stakeholder collaboration in active forest management, and explains what new legislation could mean for hunters, anglers, and forest health nationwide.   Key Takeaways for Hunters, Anglers, and Outdoor Enthusiasts: Selling federal public lands can create long-term problems for outdoor access if not done with careful analysis and forethought. The Farm Bill and upcoming federal funding deadlines could reshape conservation priorities. The Sport Fish Restoration and Boating Trust Fund is vital for fisheries and boating programs. Shark depredation is a growing problem for saltwater anglers. Forest management legislation, including the Fix Our Forests Act, could impact wildfire prevention. Collaboration between government, industry, and conservation groups is essential for sustainable outdoor policy.   Whether you're passionate about public lands, fisheries, or forestry, this episode will keep you informed on the policy debates shaping the future of hunting, fishing, and outdoor recreation in America.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter                Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter                Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

In the 5th anniversary year of the National Education Policy 2020, the NIPUN Bharat Mission, which was launched a year later- with its emphasis on foundational learning for all children in Grades 1-3 was adopted by many states in the form of their own programmes. Uttar Pradesh was one of the early adopters of an FLN programme across more than 1.1 lakh FLN-grade schools. UP is currently achieving 68% proficiency in Language and 64% proficiency in Math as part of its FLN programme.Starting with today's episode, on the occasion of Teachers' Day, The Indian Express in association with Central Square Foundation brings to you a five part series, where we will discuss the importance of Foundational Literacy with experts of the field.And to learn how UP reached where it is today, we are joined by Vinod Karate, Sr. Project Director, FLN Reforms, CSF and Vaibhav Limaye, who has been embedded with the Samagra Shiksha department in Lucknow, to understand how the change is taking shape.Hosted and produced by Niharika NandaEdited and mixed by Suresh Pawar

Discover the latest hunting, fishing, and conservation updates shaping outdoor opportunities across the country. In this episode of The Sportsmen's Voice Roundup, we break down major updates in hunting, fishing, and conservation news that matter to every outdoorsman. The U.S. Fish and Wildlife Service has expanded hunting and fishing access across 11 states, opening up new opportunities for sportsmen nationwide. We also cover New York's decision to officially include crossbows in its archery season—a win that hunters and conservationists have pushed for over 15 years. Meanwhile, Louisiana continues to see landmark legislative progress, from expanding black bear hunting opportunities to revitalizing historic waterfowl hunting areas. These bipartisan victories demonstrate how strong collaboration among hunters, anglers, and conservation groups is driving meaningful change. We also dive into the importance of modern muzzleloading technology, the role of updated regulations in creating better hunting practices, and how expanded outdoor opportunities fuel critical conservation funding. If you're passionate about hunting, fishing, and protecting America's outdoor heritage, this episode delivers the must-know updates shaping the future of our sports.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/   Follow The Sportsmen's Voice wherever you get your podcasts: https://podfollow.com/1705085498  Learn more about your ad choices. Visit megaphone.fm/adchoices

Explore new hunting and fishing laws shaping access, conservation, and the future of outdoor sports. In this week's Sportsmen's Voice podcast roundup, we dive into the latest news impacting hunters, anglers, and outdoor enthusiasts nationwide. We cover a groundbreaking executive order designed to expand saltwater fishing access, along with Montana's finalized 2025–2026 hunting and fishing regulations. The episode highlights Hunting Heritage Protection Acts in the Northeast, ensuring public access and preserving our outdoor traditions. We also examine a new two-tier program that lowers barriers for beginner duck hunters, the growing push to bring hunter education into schools, and the economic impact of recreational fishing across the U.S. Whether you're passionate about hunting conservation, fishing opportunities, or the future of outdoor access, this episode is packed with updates every sportsman needs to know. Takeaways New executive order expands saltwater fishing opportunities for recreational anglers. Montana finalizes statewide wildlife and fisheries regulations for 2025–2026. Hunting Heritage Protection Acts safeguard public access for hunters and anglers. Two-tier duck hunting program makes it easier for new waterfowl hunters to get started. Hunter education in schools helps recruit and train the next generation of sportsmen. Protecting hunting and fishing access on public lands remains a top priority. Recreational fishing continues to deliver massive economic benefits to local communities. Stronger collaboration between agencies, conservation groups, and sportsmen is essential.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/   Follow The Sportsmen's Voice wherever you get your podcasts: https://podfollow.com/1705085498  Learn more about your ad choices. Visit megaphone.fm/adchoices

Discover how the Sport Fish Restoration Fund fuels fishing fisheries conservation across America. For 75 years, the Sport Fish Restoration and Boating Trust Fund has been the backbone of fishing and conservation in the U.S. This episode explores how the Fund works, why it matters, and what's needed to ensure its future. Experts break down the mechanics of the fund—how excise taxes on fishing gear, tackle, boats, and fuel are transformed into billions of dollars for state-level conservation programs. We dig into how these dollars support habitat restoration, fish stocking, boating access, and R3 initiatives that bring new  anglers into the outdoors. The conversation also tackles pressing challenges, from legislative threats in Washington to the ongoing need for education and advocacy with policymakers. Listeners will hear why partnerships between state agencies, manufacturers, and conservation groups are critical for keeping the fund strong. Whether you're an avid angler or other conservation-minded outdoorsman, this discussion reveals the economic, cultural, and environmental impact of a program that has shaped the outdoor heritage we enjoy today. Takeaways: The Sport Fish Restoration Fund remains a cornerstone of conservation in the U.S. Funding comes from excise taxes on fishing equipment and motorboat fuel. R3 programs are vital for recruiting new anglers. Fishing contributes billions to the American economy annually. The 75th anniversary is a chance to celebrate and advocate for the future of conservation funding.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter                Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

From Florida's first black bear hunt in a decade to new pheasant camps in the Plains, Fred Bird breaks down your weekly outdoor news and the biggest stories in hunting, fishing, and conservation across the nation.  We kick off with Florida's black bear hunt returning for the first time in 10 years. The Florida Fish and Wildlife Commission voted unanimously to reinstate a highly regulated season with limited tags and fair-chase methods, marking a major win for science-based wildlife management. In Delaware, Governor Matt Meyer officially joins the Governor's Sportsmen's Caucus, strengthening bipartisan support for hunting, angling, and outdoor heritage at the state and national level. Meanwhile, Western states face conservation funding challenges, with agencies in Washington and Oregon navigating historic budget shortfalls that could impact hatcheries, pheasant programs, and wildlife access. On a brighter note, new hunter opportunities are launching in the Great Plains, including South Dakota's first youth deer camp and Nebraska's ladies pheasant hunt program—designed to mentor and recruit the next generation of outdoorsmen and women. Finally, we highlight a prescribed fire project in Kentucky's Daniel Boone National Forest, a critical initiative to restore white oak habitat, strengthen wildlife populations, and support industries like bourbon and wood products. Whether it's hunting policy, fishing access, or other conservation programs, The Sportsmen's Voice is your trusted source for outdoor news that matters.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/   Follow The Sportsmen's Voice wherever you get your podcasts: https://podfollow.com/1705085498  Learn more about your ad choices. Visit megaphone.fm/adchoices

Multiple system atrophy is a rare, sporadic, adult-onset, progressive, and fatal neurodegenerative disease. Accurate and early diagnosis remains challenging because it presents with a variable combination of symptoms across the autonomic, extrapyramidal, cerebellar, and pyramidal systems. Advances in brain imaging, molecular biomarker research, and efforts to develop disease-modifying agents have shown promise to improve diagnosis and treatment. In this episode, Casey Albin, MD speaks with Tao Xie, MD, PhD, author of the article “Multiple System Atrophy” in the Continuum® August 2025 Movement Disorders issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Xie is director of the Movement Disorder Program, chief of the Neurodegenerative Disease Section in the department of neurology at the University of Chicago Medicine in Chicago, Illinois. Additional Resources Read the article: Multiple System Atrophy Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Full episode transcript available here Dr. Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Albin: Hello everyone, this is Dr Casey Albin. Today I'm interviewing Dr Tao Xie about his article on diagnosis and management of multiple system atrophy, which appears in the August 2025 Continuum issue on movement disorders. Welcome to the podcast, and please introduce yourself to our audience. Dr Xie: Thank you so much, Dr Albin. My name is Tao Xie, and sometimes people also call me Tao Z. I'm a mood disorder neurologist, professor of neurology at the University of Chicago. I'm also in charge of the mood disorder program here, and I'm the section chief in the neurodegenerative disease in the Department of Neurology at the University of Chicago Medicine. Thank you for having me, Dr Albin and Dr Okun and the American Academy of Neurology. This is a great honor and pleasure to be involved in this education session. Dr Albin: We are delighted to have you, and thank you so much for the thoughtful approach to the diagnosis and management. I really want to encourage our listeners to check out this article. You know, one of the things that you emphasize is multiple system atrophy is a fairly rare condition. And I suspect that clinicians and trainees who even have a fair amount of exposure to movement disorders may not have encountered that many cases. And so, I was hoping that you could just start us off and walk us through what defines multiple system atrophy, and then maybe a little bit about how it's different from some of the more commonly encountered movement disorders. Dr Xie: This is a really good question, Dr Albin. Indeed, MSA---multisystem atrophy----is a rare disease. It is sporadic, adult-onset, progressive, fatal neurodegenerative disease. By the name MSA, multisystem atrophy. Clinically, it will present with multiple symptoms and signs involving multiple systems, including symptoms of autonomic dysfunction and symptoms of parkinsonism, which is polyresponsive to the levodopa treatment; and the symptom of cerebellar ataxia, and symptom of spasticity and other motor and nonmotor symptoms. And you may be wondering, what is the cause- underlying cause of these symptoms? Anatomically, we can find the area in the basal ganglia striatonigral system, particularly in the putamen and also in the cerebellar pontine inferior, all of the nuclear area and the specific area involved in the autonomic system in the brain stem and spinal cord: all become smaller. We call it atrophy. Because of the atrophy in this area, they are responsible for the symptom of parkinsonism if it is involved in the putamen and the cerebral ataxia, if it's involved in the pons and cerebral peduncle and the cerebellum. And all other area, if it's involved in the autonomic system can cause autonomic symptoms as well. So that's why we call it multisystem atrophy. And then what's the underlying cellular and subcellular pathological, a hallmark that is in fact caused by misfolded alpha-synuclein aggregate in the oligodontia site known as GCI---glial cytoplasmic increasing bodies---in the cells, and sometimes it can also be found in the neuronal cell as well in those areas, as mentioned, which causes the symptom. But clinically, the patient may not present all the symptoms at the same time. So, based on the predominant clinical symptom, if it's mainly levodopa, polyresponsive parkinsonism, then we call it MSAP. If it's mainly cerebellar ataxia, then we call it MSAC. But whether we call it MSP or MSC, they all got to have autonomic dysfunction. And also as the disease progresses, they can also present both phenotypes together. We call that mixed cerebellar ataxia and parkinsonism in the advanced stage of the disease. So, it is really a complicated disease. The complexity and the similarity to other mood disorders, including parkinsonism and the cerebellar ataxia, make it really difficult sometimes, particularly at the early stages of disease, to differentiate one from the other. So, that was challenging not only for other professionals, general neurologists and even for some movement disorder specialists, that could be difficult particularly if you aim to make an accurate and early diagnosis. Dr Albin: Absolutely. That is such a wealth of knowledge here. And I'm going to distill it just a little bit just to make sure that I understand this right. There is alpha-synuclein depositions, and it's really more widespread than one would see maybe in just Parkinson's disease. And with this, you are having patients present with maybe one of two subtypes of their clinical manifestations, either with a Parkinson's-predominant movement disorder pattern or a cerebellar ataxia type movement disorder pattern. Or maybe even mixed, which really, you know, we have to make things quite complicated, but they are all unified and having this shared importance of autonomic features to the diagnosis. Have I got that all sort of correct? Dr Xie: Correct. You really summarize well. Dr Albin: Fantastic. I mean, this is quite a complicated disease. I would pose to you sort of a case, and I imagine this is quite common to what you see in your clinic. And let's say, you know, a seventy-year-old woman comes to your clinic because she has had rigidity and poor balance. And she's had several falls already, almost always from ground level. And her family tells you she's quite woozy whenever she gets up from the chair and she tends to kind of fall over. But they noticed that she's been stiff,and they've actually brought her to their primary care doctor and he thought that she had Parkinson's disease. So, she started levodopa, but they're coming to you because they think that she probably needs a higher dose. It's just not working out very well for her. So how would you sort of take that history and sort of comb through some of the features that might make you more concerned that the patient actually has undiagnosed multiple systems atrophy? Dr Xie: This is a great case, because we oftentimes can encounter similar cases like this in the clinic. First of all, based on the history you described, it sounds like an atypical parkinsonism based on the slowness, rigidity, stiffness; and particularly the early onset of falls, which is very unusual for typical Parkinson disease. It occurs too early. If its loss of balance, postural instability, and fall occurred within three years of disease onset---usually the motor symptom onset---then it raises a red flag to suspect this must be some atypical Parkinson disorders, including multiple system atrophy. Particularly, pou also mentioned that the patient is poorly responsive to their levodopa therapy, which is very unusual because for Parkinson disease, idiopathic Parkinson disease, we typically expect patients would have a great response to the levodopa, particularly in the first 5 to 7 years. So to put it all together, this could be atypical parkinsonism, and I could not rule out the possibility of MSA. Then I need to check more about other symptoms including autonomic dysfunction, such as orthostatic hypertension, which is a blood pressure drop when the patient stands up from a lying-down position, or other autonomic dysfunctions such as urinary incontinence or severe urinary retention. So, in the meantime, I also have to put the other atypical Parkinson disorder on the differential diagnosis, such as PSP---progressive supranuclear palsy---and the DLBD---dementia with Lewy body disease.---Bear this in mind. So, I want to get more history and more thorough bedside assessment to rule in or rule out my diagnosis and differential diagnosis. Dr Albin: That's super helpful. So, looking for early falls, the prominence of autonomic dysfunction, and then that poor levodopa responsiveness while continuing to sort of keep a very broad differential diagnosis? Dr Xie: Correct. Dr Albin: One of the things that I just have to ask, because I so taken by this, is that you say in the article that some of these patients actually have preservation of smell. In medical school, we always learn that our Parkinson's disease patients kind of had that early loss of smell. Do you find that to be clinically relevant? Is that- does that anecdotally help? Dr Xie: This is a very interesting point because we know that the loss of smelling function is a risk effect, a prodromal effect, for the future development of Parkinson disease. But it is not the case for MSA. Strange enough, based on the literature and the studies, it is not common for the patient with MSA to present with anosmia. Some of the patients may have mild to moderate hyposmia, but not to the degree of anosmia. So, this is why even in the more recent diagnosis criteria, the MDS criteria published 2022, it even put the presence of anosmia in the exclusion criteria. So, highlight the importance of the smell function, which is well-preserved for the majority in MSA, into that category. So, this is a really interesting point and very important for us, particularly clinicians, to know the difference in the hyposmia, anosmia between the- we call it the PD, and the dementia Lewy bodies versus MSA. Dr Albin: Fascinating. And just such a cool little tidbit to take with us. So, the family, you know, you're talking to them and they say, oh yes, she has had several fainting episodes and we keep taking her to the primary care doctor because she's had urinary incontinence, and they thought maybe she had urinary tract infections. We've been dealing with that. And you're sort of thinking, hm, this is all kind of coming together, but I imagine it is still quite difficult to make this diagnosis based on history and physical alone. Walk our listeners through sort of how you're using MRI and DAT scan and maybe even some other biomarkers to help sort of solidify that diagnosis. Dr Xie: Yeah, that's a wonderful question. Yeah. First of all, UTI is very common for patients with MSA because of urinary retention, which puts them into a high risk of developing frequent UTI. That, for some patients, could be the very initial presentation of symptoms. In this case, if we check, we say UTI is not present or UTI is present but we treat it, then we check the blood pressure and we do find also hypertension---according to new diagnosis criteria, starting drop is 20mm mercury, but that's- the blood pressure drop is ten within three minutes. And also, in the meantime the patients present persistent urinary incontinence even after UTI was treated. And then the suspicion for MS is really high right at this point. But if you want increased certainty and a comfortable level on your diagnosis, then we also need to look at the brain MRI mark. This is a required according to the most recent MDS diagnosis criteria. The presence of the MRI marker typical for MSA is needed for the diagnosis of clinically established MSA, which holds the highest specificity in the clinical diagnosis. So then, we have- we're back to your question. We do need to look at the brain MRI to see whether evidence suggestive of atrophy around the putamen area, around the cerebellar pontine inferior olive area, is present or not. Dr Albin: Absolutely. That's super helpful. And I think clinicians will really take that to sort of helping to build a case and maybe recognizing some of this atypical Parkinson's disease as a different disease entity. Are there any other biomarkers in the pipeline that you're excited about that may give us even more clarity on this diagnosis? Dr Xie: Oh, yeah. This is a very exciting area. In terms of biomarker for the brain imaging, particularly brain MRI, in fact, today there's a landmark paper just published in the Java Neurology using AI, artificial intelligence or machine learning aid, diagnoses a patient with parkinsonism including Parkinson's disease, MSA, and PSP, with very high diagnostic accuracy ranging from 96% to 98%. And some of the cases even were standard for autopsy, with pathological verification at a very high accurate rate of 93.9%. This is quite amazing and can really open new diagnosis tools for us to diagnose this difficult disease; not only in an area with a bunch of mood disorder experts, but also in the rural area, in the area really in need of mood disorder experts. They can provide tremendous help to provide accurate, early diagnosis. Dr Albin: That's fantastic and I love that, increasing the access to this accurate diagnosis. What can't artificial intelligence do for us? That's just incredible. Dr Xie: And also, you know, this is just one example of how the brain biomarker can help us. Theres other---a fluid biomarker, molecular diagnostic tools, is also available. Just to give you an example, one thing we know over the past couple years is skin biopsy. Through the immunofluorescent reaction, we can detect whether the hallmark of abnormally folded, misfolded, and the phosphorate, the alpha-synuclein aggregate can be found just by this little pinch of skin biopsy. Even more advanced, there's another diagnosis tool we call the SAA, we call the seizure amplification assay, that can even help us to differentiate MSA from other alpha-synucleinopathy, including Parkinson disease and dementia with Lewy bodies. If we get a little sample from CSF, spinal cerebral fluids, even though this is probably still at the early stage, a lot of developments still ongoing, but this, this really shows you how exciting this area is now. We're really in a fast forward-moving path now. Dr Albin: It's really incredible. So, lots coming down the track in, sort of, MRI, but also with CSF diagnosis and skin biopsies. Really hoping that we can hone in some of those tools as they become more and more validated to make this diagnosis. Is that right? Dr Xie: Correct. Dr Albin: Amazing. We can talk all day about how you manage these in the clinic, and I really am going to direct our listeners to go and read your fantastic article, because you do such an elegant job talking about how this takes place in a multidisciplinary setting, if at all possible. But as a neurointensivist, I was telling you, we have so much trouble in the hospital. We have A-lines, and we have the ability to get rapid KUBs to look at Ilias, and we can have many people as lots of diagnosis, and we still have a lot of trouble treating autonomiclike symptoms. Really, really difficult. And so, I just wanted to kind of pick your brain, and I'll start with just the one of orthostatic hypotension. What are some of the tips that you have for, you know, clinicians that are dealing with this? Because I imagine that this is quite difficult to do without patients. Dr Xie: Exactly. This is indeed a very difficult symptom to deal with, particularly at an outpatient setting. But nowadays with the availability of more medication---to give an example, to treat patients with orthostatic hypertension, we have not only midodrine for the cortisol, we also have droxidopa and several others as well. And so, we have more tools at hand to treat the patient with orthostatic hypertension. But I think the key thing here, particularly for us to the patient at the outpatient setting: we need to educate the patient's family well about the natural history of the disease course. And we also need to tell them what's the indication and the potential side effect profile of any medication we prescribe to them so that they can understand what to expect and what to watch for. And in the meantime, we also need to keep really effective and timely communication channels, make sure that the treating physician and our team can be reached at any time when the patient and family need us so that we can be closely monitoring, their response, and also monitoring potential side effects as well to keep up the quality of care in that way. Dr Albin: Yeah, I imagine that that open communication plays a huge role in just making sure that patients are adapting to their symptoms, understanding that they can reach out if they have refractory symptoms, and that- I imagine this takes a lot of fine tuning over time. Dr Xie: Correct. Dr Albin: Well, this has just been such a delight to get to talk to you. I really feel like we could dive even deeper, but I know for the sake of time we have to kind of close out. Are there any final points that you wanted to share with our listeners before we end the interview? Dr Xie: I think for the patients, I want them to know that nowadays with advances in science and technology, particularly given a sample of rapid development in the diagnostic tools and the multidisciplinary and multisystemic approach to treatment, nowadays we can make an early and accurate diagnosis of the MSA, and also, we can provide better treatment. Even though so far it is still symptomatically, mainly, but in the near future we hope we can also discover disease-modifying treatment which can slow down, even pause or prevent the disease from happening. And for the treating physician and care team professionals, I just want them to know that you can make a difference and greatly help the patient and the family through your dedicated care and also through your active learning and innovative research. You can make a difference. Dr Albin: That's amazing and lots of hope for these patients. Right now, you can provide really great care to take care of them, make an early and accurate diagnosis; but on the horizon, there are really several things that are going to move the field forward, which is just so exciting. Again today, I've been really greatly honored and privileged to be able to talk to Dr Tao Xie about his article on diagnosis and management of multiple system atrophy, which appears in the August 2025 Continuum issue on movement disorders. Be sure to check out Continuum Audio episodes for this and other issues. And thank you again to our listeners for joining us today. Dr Xie: Thank you so much for having me. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

From Florida's black bear season decision to nationwide hunting regulation changes, here's what every outdoorsman should know.   In this episode, we dive deep into today's historic Florida Fish and Wildlife Commission vote on reinstating the black bear hunting season. Mark Lance joins us to explore the science-based wildlife management strategies behind the proposal, the surge in Florida's bear population, and how public sentiment—often driven by emotion—shapes these debates. We examine historical bear management in the state, evolving bear hunting methods such as baiting and the use of dogs, and what the commission's decision could mean for conservation.   The conversation then shifts to nationwide hunting and conservation policy updates, including the reauthorization of Wisconsin's Knowles-Nelson Stewardship Fund for public lands, Wyoming's open-door approach to public legislative input, and new regulations improving hunter access across the Northeast. We highlight state-level changes such as Maryland's approval of artificial lights for deer recovery, New York's inclusion of crossbows in archery season, and New Hampshire's decision to allow air rifles for big game hunting.   We also cover the proposed Wisconsin season for sandhill cranes, the SHARKED Act's approach to shark depredation, and the importance of sportsmen staying engaged with legislative processes. Whether you hunt, fish, or simply care about wildlife management, these updates will keep you informed on the policies shaping the great outdoors.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/   Follow The Sportsmen's Voice wherever you get your podcasts: https://podfollow.com/1705085498  Learn more about your ad choices. Visit megaphone.fm/adchoices

State-level conservation issues are heating up across the country as outdoor seasons approach. The Sportsmen's Voice Host Fred Bird welcomes back CSF's own Marie Neumiller to break down changing wolf management strategies in Idaho and Montana—including the use of ABC population modeling and legal challenges to trapping seasons due to grizzly bear protections. The conversation then turns to national conservation updates, including: The Senate's confirmation of Brian Nesvik, a lifelong outdoorsman, as Director of the U.S. Fish and Wildlife Service. The fight to protect surf fishing access in South Carolina, with legislative sportsmen stepping in to stop a proposed ban that would have impacted anglers and conservation funding alike. Massachusetts' debate over providing free hunting and fishing licenses to disabled veterans—well-intentioned, but with potential risks to the state's conservation funding. A look at Missouri's proposal to expand nighttime coyote hunting, offering more opportunity for predator control and sportsmen alike. Whether you're into wolf conservation, fishing access, or predator management, this episode is packed with insights for hunters, anglers, and anyone passionate about protecting America's outdoor heritage.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Can oil rigs actually improve marine habitats and fishing opportunities in the Gulf? The answer is an unequivocal “YES”, as this feature episode of The Sportsmen's Voice Podcast details.    Host Fred Bird is joined by CSF's Chris Horton and Kevin Bruce from Arena Energy to discuss the Rigs to Reef program—a vital conservation initiative for saltwater anglers, commercial fishermen, and outdoor enthusiasts alike. The conversation dives deep into how decommissioned oil platforms in the Gulf of America are being transformed into artificial reefs that support marine biodiversity, enhance sportfishing opportunities, and fuel local outdoor economies, along with the challenges this program faces.   They explore: Why reefing-in-place helps conserve and protect marine ecosystems and coastal fishing access, How permitting bottlenecks threaten reef development, The bipartisan push for legislation that supports this critical marine infrastructure, and Highlights from the new documentary Steel To Sanctuary, which sheds light on the reefing effort and its impact on fishermen, divers, and coastal communities.   Whether you're a saltwater angler, conservation advocate, or part of the outdoor industry, this episode breaks down how some offshore energy infrastructure can be part of a healthy future for America's marine fisheries.   Learn more about the Rigs to Reef initiative and how you can support marine conservation efforts at the intersection of policy, ecology, and the outdoor recreation economy. Watch Steel To Sanctuary - The Rigs To Reefs Story: https://rigstoreef.com    Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter                Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices